Clin Auton Res (2005) 15 : 420 DOI 10.1007/s10286-005-0316-1
3. Flachenecker P, Wolf A, Krauser M, Har-tung HP, Reiners K (1999) Cardiovascu-lar autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance. J Neurol 246:578–586 4. Hilz MJ, Hecht MJ, Mittelhamm F,
Neun-dorfer B, Brown CM (2002) Baroreflex stimulation shows impaired cardiovagal and preserved vasomotor function in early-stage amyotrophic lateral sclero-sis. Amyotroph Lateral Scler Other Mo-tor Neuron Disord 3:137–144
E. O. Sanya · M. Tutaj · C. M. Brown · N. Goel · B. Neundörfer · M. J. Hilz Dept. of Neurology University of Erlangen-Nuremberg Erlangen, Germany Dr. E. O. Sanya Dept. of Medicine
University of Ilorin Teaching Hospital PMB1459
Ilorin State, Nigeria Dr. C. M. Brown ()
Dept. of Medicine, Division of Physiology University of Fribourg Ch. du Musée 5 1700 Fribourg, Switzerland Tel.: +41-26/300-8600 Fax: +41-26/300-9734 E-Mail: clivemartin.brown@unifr.ch M. Tutaj Dept. of Neurology Jagiellonian University Krakow, Poland
LETTER TO THE EDITORS
CAR 316 Emmanuel O. Sanya Marcin Tutaj Clive M. Brown Nursel Goel Bernhard Neundörfer Max J. Hilz
Response to
Flachenecker et al.
Abnormal baroreflex responses
in Multiple sclerosis
Sirs: We thank Dr. Flachenecker and Dr. Reiners for their interesting comments regarding our recent paper investigating baroreflex re-sponses in patients with multiple sclerosis (MS). Our findings are consistent with their reports [1–3], and reaffirm the concept that sympathetic vasomotor dysfunc-tion may be present in MS patients, and should be considered when performing routine autonomic tests in these patients.
We agree with Dr. Flachencker and Dr. Reiners that in most cases the routine measurement of stand-ing blood pressure and heart rate
are adequate. However, although our technique of sinusoidal neck suction is rather complex, particu-larly for routine clinical use, it does have some advantages. One is that only a relatively passive co-opera-tion is required from the patient, making it possible to apply the procedure even in patients who are unable to perform the standard cardiovascular reflex tests. Another is the ability to detect subtle auto-nomic dysfunction at early disease stages, even before the appearance of overt autonomic symptoms [4]. Further work is required to estab-lish the usefulness of the method in screening for orthostatic dizziness in patients with diseases affecting the autonomic nervous system.
References
1. Flachenecker P, Reiners K, Krauser M, Wolf A, Toyka KV (2001) Autonomic dysfunction in multiple sclerosis is re-lated to disease activity and progression of disability. Mult Scler 7:327–334 2. Flachenecker P, Rufer A, Bihler I, Hippel
C, Reiners K, Toyka KV, Kesselring J (2003) Fatigue in MS is related to sym-pathetic vasomotor dysfunction. Neu-rology 61:851–853
